Efficacy of progressive resistance training interventions in older adults in nursing homes: a systematic review

ObjectiveTo provide a synthesis of the evidence from clinical trials to determine whether progressive resistance training, as a single exercise intervention, improves strength and functional performance in older institutionalized adults.MethodsA comprehensive systematic database search for randomized controlled trials was performed, including AMED, CINAHL, COCHRANE, and all EMB reviews: Cochrane DSR, ACP Journal Club, DARE, MEDLINE, PREMEDLINE, and PsycINFO, completed in July 2011. Studies were then assessed for potential inclusion. Study quality indicators, cohort characteristics, training intervention, muscle strength, and functional performance outcomes were extracted.ResultsThirteen studies were reviewed; the mean cohort age range was 80 to 89 years. In general, the quality of the reviewed studies was moderately robust; an average of 9 of 11 quality criteria were accounted for in the reviewed literature. Significant improvements were found in muscle strength outcomes and functional performance outcomes, including chair to stand time, stair climbing, gait speed, balance, and functional capacity following progressive resistance training interventions.ConclusionsSignificant improvements in muscle strength and functional performance occur in response to progressive resistance training exercise, despite advanced age, presence of chronic diseases, extremely sedentary habits, and functional disabilities in older institutionalized individuals. Therefore, the incorporation of a progressive resistance training exercise program is an effective means to preserve independence levels by maintaining or improving the ability to perform activities of daily living and the implementation of this type of exercise program should be promoted and incorporated into the recreational schedules of long term care institutions.     

Extreme temperatures and mortality in the North of Spain

Objective  

To study the relationship between mortality and temperature in Cantabria, a Spanish region that includes both rural and urban areas.     

Macroanatomy and Microanatomy of the Temporal Lobe

Because of its different functions and organization, the temporal lobe may be divided into lateral and medial parts. This separation may be useful for teaching purposes, since the medial temporal lobe needs a separated and a more precise study because of its complex structure and because it is the substrate where some specific types of epilepsy originate. The use of certain magnetic resonance imaging (MRI) sequences and protocols has improved the diagnosis of some particular epilepsies, but this technical benefit must be accompanied by the accurate knowledge of the anatomy of the temporal lobe. With this purpose we have prepared this article, which highlights the ultastructural and macroanatomy of the temporal lobe seen on MRI.     

Differing effects of T4 DNA ligase in the modulation of the damage induced in mammalian cells by either X-rays or restriction endonucleases

BACKGROUND: Of the different lesions induced by X-rays, DNA double-strand breaks (DSBs) are considered the main cause of chromosomal aberrations and cell death. Restriction endonucleases (REs) induce only DNA DSBs and have frequently been used to mimic the effects of ionizing radiation in the study of DNA damage and repair. METHODS: The present work makes use of clonogenic and cytogenetic assays to study the effect of T4 DNA ligase on modulating the damage induced by either X-rays or an RE (MspI) that produces breaks with cohesive ends. A CHO cell line defective in ligase III activity (EM9) and its corresponding parental line (AA8) were used. RESULTS: Our results show that T4 DNA ligase increased cell survival and decreased chromosomal aberrations in cells treated with MspI, suggesting that most RE-induced DSBs can be repaired by a simple ligation. This enzyme was, however, unable to promote repair of the DNA damage induced by X-rays. Analysis of the ratios of exchange-type aberrations to chromatid break-type aberrations indicated that T4 ligase increased misrejoining of the DNA damage induced by X-rays. The results were similar in EM9 and AA8 cells, although the effect was greater in the cells deficient in DNA strand break rejoining. In addition, depending on whether the end strand break structure is 3'-hydroxyl and 5'-phosphoryl (REs) or more complex (X-rays), T4 DNA ligase could either promote the correct repair or, conversely, increase misrejoining. CONCLUSION: The present results confirm the idea that DNA DSBs induced by cohesive cutting RE are repaired by different mechanisms than those induced by X-rays causing cell lethality.     

Comparative analysis of clinical, biochemical and genetic aspects associated with bone mineral density in small for gestational age children

Clinical, biochemical and genetic analysis related to bone mineral density (BMD) were carried out in children born small for gestational age (SGA) that failed to achieve postnatal catch-up growth (CUG), SGA children that completed CUG and adequate for gestational age (AGA) children. Serum IGF-I, IGF-II, IGF binding protein-3 and acid-labile subunit were lower in the SGA-CUG children as compared with the other groups. Frequencies of polymorphic variants of vitamin D receptor, estrogen receptor and collagen genes were similar among groups. The genotype 194-192 of the IGF-I gene was higher in the SGA-CUG and 196-192 was higher in the SGA+CUG group. In the SGA-CUG group, the genotype SS of the COLIA1 gene was associated with lower BMD. Therefore, IGF system and COLIA1 polymorphism distinguish prepubertal SGA-CUG children from the SGA+CUG children of the same age. Furthermore, COLIA1 polymorphism could be useful to predict osteopenia in SGA-CUG children.     

Midvastus approach in total knee arthroplasty: a description and a cadaveric study determining the distance of the popliteal artery from the patellar margin of the incision.

Total knee arthroplasty (TKA), one of the most efficacious procedures in orthopedics, requires complete exposure of the knee joint for precise instrumentation. Although most orthopedic surgeons agree that TKA is easily performed using a medial parapatellar approach, a large segment of the patellar blood flow is disrupted by this exposure. The southern or subvastus approach addresses these concerns; however, the procedure has the disadvantage of inadequate exposure in certain patients. A compromise between these two approaches, a midvastus approach, has been described. To decrease potential neurovascular injury, this cadaveric study of the midvastus approach determines the proximity of the incision to the popliteal vascular bundle and addresses the innervation pattern of the vastus medialis oblique. A midvastus arthrotomy was performed on 19 female and 15 male adult cadaveric knees. The midpoint of the superior pole of the patella and the superomedial patellar prominence were marked. After determining the midpoint between the 2 previously mentioned landmarks, an incision was made from that point paralleling the fibers of the vastus medialis oblique medially to the popliteal vascular bundle. The length of the incision was measured three times using calipers; measurements were averaged for each individual specimen, then by gender, and, finally, overall. Ninety-five percent confidence intervals were determined. Differences were assessed by an independent t-test with an alpha level of significance at .05. In addition, the terminal branches of the femoral nerve innervating the vastus medialis oblique were dissected in 5 cadavers. The femoral nerve branched extensively to innervate the vastus medialis oblique. The average distance between the patella and the popliteal vessels was 8.8 +/- 1.4 cm. The average distance in males, 9.5 +/- 1.4 cm, was significantly greater than the distance in females, 8.3 +/- 1.2 cm (P < .02). The distance appeared proportionate to the size of the extremity. The midvastus approach is a viable alternative for primary TKA in selected patients who are not obese and who have not had previous arthrotomy or osteotomy. The average distance (8.8 cm) and corresponding range (6.5 cm minimum to 12.3 cm maximum) are sufficient to suggest a maximal safe distance for sharp dissection of 4.5 cm from the patellar margin in an adult. For additional exposure, the muscle can be safely split further with blunt dissection.     

Dynamics of skeletal resistance to parathyroid hormone in the rat: effect of renal failure and dietary phosphorus.

Secondary hyperparathyroidism develops in renal failure and is generally ascribed to factors directly affecting parathyroid hormone (PTH) production and/or secretion. These include hypocalcemia, phosphorus retention, and a calcitriol deficiency. However, not often emphasized is that skeletal resistance to PTH is an important factor. Our study evaluated: (1) the relative effects of uremia and dietary phosphorus on the skeletal resistance to PTH; and (2) how, during a PTH infusion, the dynamics of skeletal resistance to PTH were affected by renal failure. Renal failure was surgically induced and, based on serum creatinine, rats were divided into normal, moderate renal failure, and advanced renal failure. In each group, three diets with the same calcium (0.6%) but different phosphorus contents were used: high (1.2%, HPD); moderate (0.6%, MPD); and low (0.2%, LPD) phosphorus. The study diet was given for 14-16 days followed by a 48 h infusion of rat PTH(1-34) (0.11 microg/100 g per hour), a dose five times greater than the normal replacement dose. During the PTH infusion, rats received a calcium-free, low phosphorus (0.2%) diet. In both moderate and advanced renal failure, the PTH level was greatest in the HPD group (p < 0.05) and, despite normal serum calcium values, PTH was greater in the MPD than the LPD group (p < 0.05). Despite phosphorus restriction and normal serum calcium and calcitriol levels in the azotemic LPD groups, the PTH level was greater (p < 0.05) in the LPD group with advanced rather than moderate renal failure. During PTH infusion, the increase in serum calcium was progressively less (p < 0.05) in all groups as renal function declined. Furthermore, despite normal and similar serum phosphorus values at the end of PTH infusion, the serum calcium concentration was less (p < 0.05) in the HPD group than the other two groups and similar in the LPD and MPD groups. In conclusion: (1) uremia and phosphorus each had separate and major effects on skeletal resistance to PTH; (2) skeletal resistance to PTH was an important cause of secondary hyperparathyroidism, even in moderate renal failure; (3) during PTH infusion, the dynamics of skeletal resistance to PTH changed because all groups received a low phosphorus diet, and the adaptation to a new steady state was delayed by the degree of renal failure and the previous dietary phosphorus burden; and (4) normal serum phosphorus may not be indicative of body phosphorus stores during states of disequilibrium.     

Nodular lichen myxoedematous: a new adverse event associated with ustekinumab

Nodular lichen myxoedematosus is a localised form of lichen myxoedematosus, a chronic idiopathic cutaneous mucinosis of known aetiology. Ustekinumab is a human interleukin-12/23 monoclonal antibody that could directly or indirectly increase mucin production. Herein, we report for the first time a case of nodular lichen myxoedematosus associated with ustekinumab.     

Blueberry muffin baby secondary to ganglioneuroblastoma

We report the case of a neonate presenting with the clinical features of blueberry muffin syndrome caused by ganglioneuroblastoma, a rare variant of neuroblastoma. This syndrome may be the only visible manifestation of a neonatal tumor and highlights the importance of early recognition and initiation of therapy to reduce mortality.